Counselling Theories and Approaches
Senior 6 · Psychology
Counselling Theories and Approaches
Lesson 5 of 5
25 min
Aline, 15, has stopped eating with the family, skips school and shouts at her father. Her parents bring her to a counsellor "to fix her". The counsellor learns that her parents have been arguing for months, that her mother confides all her worries to Aline, and that her father has withdrawn. Whenever Aline is in trouble, her parents stop fighting and unite to deal with her. Is the problem inside Aline, or in the pattern of the whole family? (An illustrative case.)
Systemic approaches answer: look at the system. This final lesson covers systemic and family systems therapy, and then the holistic and integrative approaches that most counsellors use today, drawing on everything in this unit.
Definition
Systemic approach: an approach that sees a person's problems as part of the patterns of relationships in the systems around him or her (family, school, community), and works to change those patterns.
Identified patient (or client): the family member whose symptoms bring the family to help, who may be carrying the stress of the whole system.
Circular causality: each person's behaviour is both cause and effect of others' behaviour. Example: a mother nags because her son withdraws, and he withdraws because she nags.
Integrative counselling: combining theories and techniques from different approaches into a coherent way of working, matched to each client.
Holistic approach: attending to the whole person: body, mind, emotions, relationships, spirituality, and social and economic circumstances.
Systemic counsellors borrow from systems theory: a family is more than its members, just as a football team is more than eleven players. Key ideas include circular causality; homeostasis (families tend to resist change and restore their familiar balance, even an unhappy one); subsystems (parents, siblings) and the boundaries between them; and roles that members take on, such as "the responsible one" or "the troublemaker". A genogram, a family tree drawn with standard symbols for people and relationships across three or more generations, helps families see repeating patterns.
Figure 1. A family drawn as a system (illustrative). Squares are males and circles females; the identified client has a double outline. The lines show the quality of relationships. A systemic counsellor would see Aline's problems as part of this pattern, not only as hers.
The American psychiatrist Murray Bowen developed family systems theory from the 1950s, around eight concepts. The most important for counsellors are:
The Bowenian counsellor stays calm and neutral, uses genograms, and coaches family members to lower anxiety and increase differentiation.
| Approach | Key idea | Typical technique |
|---|---|---|
| Structural family therapy (Salvador Minuchin, 1974) | Problems come from unclear structure: boundaries that are too rigid (disengaged families) or too diffuse (enmeshed families), or a confused hierarchy | "Joining" the family, then enactments and restructuring, for example strengthening the parental subsystem |
| Strategic and Milan systemic therapy | Change the patterns that keep a problem going | Circular questions ("When Aline shouts, what does your mother do? And then?"), tasks between sessions |
| Narrative therapy (Michael White and David Epston, 1990) | People live by stories about themselves; "the person is not the problem, the problem is the problem" | Externalising the problem ("How has Anger been pushing you around?") and building alternative stories |
Evidence. Reviews (for example Carr, 2019) find good evidence for family-based therapies in adolescent conduct problems and substance misuse, anorexia nervosa in young people, and preventing relapse in schizophrenia (family psychoeducation, Unit 8). Limits: it can be hard to engage all members; focusing on patterns must never hide abuse or violence, where safety comes first; and some families prefer individual help.
In 1936 Saul Rosenzweig suggested that different therapies might work equally well because they share common factors. He quoted the Dodo in Alice in Wonderland: "Everybody has won, and all must have prizes." Later reviews (Wampold and Imel, 2015) found that well-delivered therapies often have similar overall effects, and that common factors such as the working alliance, empathy, a convincing explanation and the client's hope explain much of the benefit. Critics reply that specific techniques clearly matter for some problems, such as exposure for phobias and OCD. Most counsellors today therefore integrate:
A holistic counsellor asks about the whole of a client's life: sleep, health and medication; thoughts and feelings; family and friends; faith and meaning; school, work and money. It reflects the biopsychosocial model from Unit 5, and often means working with others: a doctor, a social worker, a religious leader, a teacher. In Rwanda, community-based sociotherapy (Unit 8) is a holistic, group-based approach that rebuilds trust and social bonds as well as easing individual distress. For Aline, a holistic, integrative plan might combine family sessions on the parents' conflict, individual CBT for her mood, a check on her eating and sleep, and support from the school.
Warning
"It's a family problem" never excuses harm. Systemic counsellors look at patterns, but when there is violence or abuse, the first duty is safety: protect the person at risk and involve the right services (RIB 116 for child abuse, 3512 for gender-based violence, or the Isange One Stop Centre on 3029). Joint family sessions are not appropriate while someone is being harmed.
Important
Where to get help in Rwanda. If you, or someone you know, is struggling, talk to a trusted adult (a parent, teacher or school counsellor) and visit your local health centre. The Rwanda Biomedical Centre asks people to call its toll-free number 114 with questions about its services or in an emergency. Asking for help is a sign of strength, not weakness.
Tip
Linear versus circular. Linear: "Aline is the problem." Circular: "Each person's behaviour keeps the others' going." Lazarus's seven modalities spell BASIC I.D.; the Dodo bird says "all must have prizes" (common factors).
Practice
Further reading
Sources and credits
Written by Ganzaa: the text, the diagram (Figure 1), the table and the exercises.
